Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 012926 | NY |
NPI | 1003126103 |
---|---|
Provider Name | Miss Yelena A Shamalova |
First Address | Rego Park, NY 11374-3241 |
Second Address | Rego Park, NY 11374-3241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2010 |
Last Update Date | 08/10/2010 |